THE HEALTHY CITYDELIVERING HEALTH THROUGH ENVIRONMENTAL AND PLANNING POLICY

APRIL 2018

THE HEALTHY CITY 2PRINT

About the Council for the Environment and Infrastructure

The Council for the Environment and Infrastructure (Raad voor de

leefomgeving en infrastructuur, Rli) advises the Dutch government and

Parliament on strategic issues concerning the sustainable development

of the living and working environment. The Council is independent, and

offers solicited and unsolicited advice on long-term issues of strategic

importance to the Netherlands. Through its integrated approach and

strategic advice, the Council strives to provide greater depth and

breadth to the political and social debate, and to improve the quality

of decision-making processes.

Composition of the Council

Jan Jaap de Graeff, Chair

Marjolein Demmers MBA

Prof. Pieter Hooimeijer

Prof. Niels Koeman

Jeroen Kok

Annemieke Nijhof MBA

Ellen Peper

Krijn Poppe

Co Verdaas PhD

Junior members of the Council

Sybren Bosch MSc

Mart Lubben MSc

Ingrid Odegard MSc

General secretary

Ron Hillebrand PhD

The Council for the Environment and Infrastructure (Rli)

Bezuidenhoutseweg 30

P.O. Box 20906

2500 EX The Hague

the Netherlands

info@rli.nl

www.rli.nl

3PRINTTHE HEALTHY CITY | CONTENT

CONTENT

SUMMARY 4

PART 1: ADVICE 6

1 THE CITY AS A HEALTHY ENVIRONMENT 6

1.1 A healthy environment in the Environment and Planning Act 6

1.2 Request for advice 7

2 HEALTH AND THE BUILT ENVIRONMENT: THE BASICS 8

3 RECOMMENDATIONS: TEN OPTIONS FOR HEALTH BENEFITS 10

3.1 Recommendations to strengthen environmental policy and

the use of instruments 10

3.2 Recommendations for knowledge creation and research by

design 17

3.3 Recommendations on strengthening the financial base and

improving governance for a healthy environment 19

REFERENCES 22

APPENDICES 25

RESPONSIBILITY AND ACKNOWLEDGEMENTS 25

OVERVIEW OF PUBLICATIONS 28

4PRINTTHE HEALTHY CITY | SUMMARY

SUMMARY

One of the stated aims of the Environment and Planning Act is to

establish and maintain a healthy built and natural environment. How

that goal should take shape in policy remains unclear for many public

authorities. In this advisory report, the Council for Environment

and Infrastructure (Rli) offers its suggestions. The Council feels that

public authorities can achieve more health benefits if they go beyond

health protection (traditional environmental policy) and strive towards

health promotion. Health is more than the absence of illness. People’s

environment should reduce stress, encourage exercise and stimulate

social engagement. The Council proposes new options for environmental

and planning policy and instruments, research and design, and finance

and governance.

Bolstering policy and employing instruments

The Council believes that protecting human health is and will remain an

important policy ingredient for a healthy built and natural environment –

the Netherlands must, at the very least, comply with the environmental

standards in force. Additional health benefits will require efforts to create

an environment that enables and encourages healthy behaviour, for

example, by offering networks of footpaths, bicycle tracks and greenways

that connect cities to their surroundings. Public authorities can also

create attractive public spaces that stimulate social contact. The built and

natural environment therefore contributes to our health in the broadest

sense of the word: not just physically, but also socially by enabling social

engagement and resilience. Cities that focus exclusively on protecting

health are missing opportunities.

To enhance health benefits further, the Council recommends that

government authorities use the instruments offered by the Environment

and Planning Act to their full potential. The Council urges them to look for

opportunities for synergy, so that measures and resources deployed to one

end will help achieve others. Switching to electric transport modes (e.g. for

delivery services and buses) will improve air quality and, in turn, health. In

this, public authorities depend on each other’s cooperation. For example,

it is harder to build homes in cities bisected by motorways or main roads.

If the national government opts for compact urban development in its

National Environment Strategy (NOVI), the public health interest dictates

that this should be accompanied by national policy measures such as

investments in noise barriers or tunnels.

Fostering research and design

Promoting health through the environment will require a more solid

evidence base. The effects of health-promoting measures should be better

understood, and the results of local interventions better communicated.

The Council recommends developing new tools, such as health maps and

environmental health stress tests, to assist in this endeavour. Urban design

5PRINTTHE HEALTHY CITY | SUMMARY

workshops can help to bring together parties from diverse backgrounds:

not just environmental and health experts, but also residents, politicians

and entrepreneurs. Learning each other’s language will facilitate concerted

efforts towards creative solutions for improving health.

Strengthening the financial base and improving governance

A healthy environment requires a more solid financial base. When

making investments in the physical environment, consideration should

be given not only to health risks, but especially to the health benefits.

The 2018 evaluation of the Housing Act should consider whether or

not housing associations should be allowed to invest more towards a

healthy environment, liveability and public property. To overcome the

split-incentive issue, municipalities, healthcare providers and the national

government could create local prevention coalitions for the promotion of

a healthy environment. In addition, public authorities should work more

in interdisciplinary teams to bring together the often separate worlds of

environment and healthcare and take a more holistic approach to fostering

a healthy environment.

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PART 1 | ADVICE 1 The city as a healthy environment

1.1 A healthy environment in the Environment and Planning Act

One of the stated goals of the Environment and Planning Act (adopted

in 2016 and expected to take effect in 2021) is to attain and maintain a

healthy built and natural environment. Public authorities will therefore

need to explain what ‘health’ means in their environmental and planning

policies. This is proving easier said than done. How can this concept be

operationalised? How will its inclusion in the Act affect the balancing of

interests in policymaking? What opportunities does environmental policy

hold for improving health?

In this advisory report, the Council presents some suggestions. First, it

presents an alternative to relying exclusively on environmental standards

to achieve health benefits. Although the traditional environmental

protection route can still produce results, the Council feels that more

is possible if environmental and planning policy is employed not just

to protect, but also to promote health by creating an environment that

reduces stress, encourages exercise and creates opportunities for social

engagement.

Second, this advisory report offers guidance for decision-making when

drawing up plans and strategies.1 What role should a healthy environment

1 Various guides have been developed for sustainable urban development, such as the Handreiking Duurzame Ruimtelijke Ontwikkeling [Guidance on Sustainable Spatial Development] and various publications by the Platform Duurzame Gebiedsontwikkeling (DGO) [Foundation for Sustainable Area Development].

7PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 1

play in this? According to the Environment and Planning Act, the task is to

balance the interests of a healthy, clean and safe environment on the one

hand against societal objectives on the other. A healthy environment is not

necessarily the sole, overriding concern of environmental and planning

policy. The final decision will depend on the local setting and the urgency

of the various challenges at hand. The Council feels that there are good

prospects for synergy so that measures and resources deployed to one end

will contribute to other aims. Policy decisions on major developments in

the physical environment, such as climate change adaptation, the energy

transition, sustainable transport and sustainable urban development, can

all be leveraged to improve human health (and vice versa).

Achieving a healthy environment is vital. It is for good reason that

planning practitioners have embraced this goal as one of the seven most

unavoidable challenges for 2040 (Manifest 2040, 2015). Cities can set

themselves apart in their pursuit of health: a healthy environment is an

obvious competitive advantage. Moreover, placing the emphasis on health

benefits can mitigate the stigma of constraints imposed by environmental

regulations.

1.2 Request for advice

This advisory report seeks to answer the following question:

How can environmental and planning policies for urban areas be designed

to achieve health benefits? What should the national government and

subnational authorities do to enable this?

Different routes can be taken towards better health. This advisory report

concentrates solely on environmental and planning policy; it does not

go into the many other ways to improve health, such as reforming the

healthcare system or social and economic policy. In addition, this advisory

report focuses on the city. Urban areas are faced with complex and often

interrelated challenges, which demand integrated solutions if they are

to become healthy environments. The same of course applies to rural

areas, but the challenges are quite different (e.g. preventing transmission

of diseases from animals to humans). Consequently, this advisory report

focuses exclusively on the built environment.

8PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 2

2 Health and the built environment: the basics

The Council advocates taking a holistic approach based on the following

four principles:

The environment is vital to human health

Besides lifestyle, genes or wealth, the physical environment has been

proven to be one of the primary factors affecting human health. Clean air,

and the presence of footpaths and green spaces all make neighbourhoods

healthier places. The relative importance of environmental factors is

difficult to pin down, although research has shown that, after smoking,

an unhealthy environment is the most determinative factor for avoidable

illness in the Netherlands (RIVM, 2014). This figure was calculated using

only factors such as air and noise pollution: if urban planning and design

elements were to be included as well, an even greater effect could be

expected. The Council believes this justifies its focus on the impact of the

environment on health.

Health is more than the absence of illness

In this advisory report the Council takes a broad view of health that

goes beyond physical health to include mental and social wellbeing

and people’s ability to control their lives and develop social resilience.

A narrow definition of health (the absence of illness) ignores the fact

that those with chronic illnesses or disorders often feel perfectly healthy

and fully participate in society. The Council is aware that this choice for

a broad definition may make the concept more difficult to articulate in

environmental and planning policy, but also notes that this approach is

consistent with national and international insights on health. This broader

definition also allows more opportunities for improving health than just

preventing illness.

Better health = protecting + promoting health

A healthy environment enables health in a general sense. For a long time,

environmental policy concentrated on health protection: reducing damage

to human health, usually by means of environmental standards. This

advisory report argues that the scope should be widened to include health

promotion: creating environments that stimulate healthy lifestyles. This will

be explained in more detail in Recommendations 1 and 2. The sum total of

health protection and promotion is better health. This standpoint echoes

previous calls by organisations such as PBL Netherlands Environmental

Assessment Agency (PBL, 2016), the Health Council of the Netherlands and

the German Advisory Council on Global Change (WBGU, 2016) as well as

the opinions of health and environment professionals.

9PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 2

Figure 1: Better health = health protection + health promotion

A healthy indoor environment: achieving better health inside buildings

‘The environment’ is not just outdoors, but inside as well. Even though

people spend about 85% of their time indoors (Gezondheidsraad, 2013),

this fact is often overlooked in the public debate on the built environment.

A healthy indoor environment includes things like good air quality

and temperature and humidity control. Further improvements are still

possible in this regard. Nevertheless, the Council feels that, here too, the

scope should be extended to promoting health. Much can be done when

constructing and renovating buildings, such as applying the principles

of ‘exercise logic’ (e.g. the strategic placement of stairs and elevators,

see BETA office, 2016) and the WELL Building Standard (International

WELL Building Institute, 2014). Public authorities should set an example

by including health promotion in public procurement conditions for the

construction or renovation of buildings such as schools (see Box 1). It is

important to take the indoor environment into account when insulating

homes, a matter identified in the government’s coalition agreement as

a first step towards greening the existing housing stock (Tweede Kamer,

2017a). Opportunities to achieve health benefits should be seized, while

avoiding the danger of insulation making the indoor environment less

healthy (see also RIVM, 2017). Recommendation 4 will treat this in more

detail.

Box 1: Venlo Municipal Council Office

The Municipality of Venlo office building was built and furnished

according to cradle-to-cradle principles. It contributes to the health of its

staff and visitors through, for example, the use of healthy materials and

natural lighting. Outside, the building contributes to the health of the

surroundings by means of a living green wall (of vegetation), which acts

as an air filter (Gemeente Venlo, 2017).

Better health

health protection

health promotion

10PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

3 Recommendations: ten options for health benefits

The Council advises approaching the issue of environment and health

along the principles outlined above. To this end, the Council presents

ten recommendations grouped into three clusters: 1) environmental and

planning policy and instruments, 2) research and design and 3) finance and

governance. Table 1 summarises these recommendations and to whom

they are addressed. The recommendations are treated in more detail

below.

3.1 Recommendations to strengthen environmental policy and the use

of instruments

Recommendation 1: Keep working on protection: comply with current

environmental standards as a bare minimum. Prepare for tighter standards

in the future. If the local situation calls for it, use the option introduced in

the Environment and Planning Act and its associated orders in council to

set stricter local environmental standards.

The protection aspect of environmental policy remains vital for a

healthy environment. The bare minimum, the Council feels, is to meet

the environmental standards currently in force, something that is not

always achieved (Tweede Kamer, 2017b). Moreover, health can suffer

even when environmental standards like air and noise pollution are met.2

2 Even though the Netherlands generally complies with the standards, a ‘safe’ level of exposure is still much lower (Gezondheidsraad, 2016). For example, air pollution still causes considerable damage to health in the Netherlands even though EU standards are generally met (PBL, 2016; Gezondheidsraad, 2018).

Partly for this reason, the Health Council of the Netherlands advises

tightening environmental standards to the levels recommended by

health professionals (Gezondheidsraad, 2016, 2018, see also Box 2).

The Council recognises that while it is important to examine whether

standards need tightening, it also feels that the levels recommended by

health professionals should not automatically be universally applied.

National norms should only be tightened after a consideration of many

factors, such as physical viability, costs and benefits, health effects and

technical feasibility.3 The outcome of this assessment may vary from one

environmental factor to another, so that a tighter national standard might

meet the levels recommended by health professionals in some cases, but

not in others.

3 The Health Council of the Netherlands also acknowledges the importance of weighing up different factors, but only after the values recommended by health professionals have been adopted nationally (Gezondheidsraad, 2016, 2018).

11PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

Table 1: Summary of recommendations in The Healthy City

Recommendations National government

Municipality

Environmental

and planning

Keep working on protection.

The national government should prepare for tighter standards in the future.

Municipalities should use the option introduced in the Environment and Planning Act to set stricter

local environmental standards if local circumstances call for this.

x

x

Focus more on promoting health in environmental and planning policy and look further than

environmental measures to achieve this.

x x

Seek, from a health perspective, synergies with major transition challenges such as sustainable urban

development, mobility, climate change adaptation and the energy transition.

x x

Include ambitions for a healthy built environment in environment strategies and use the instruments

in the Environment and Planning Act to realise them.

x x

Prioritise the promotion of healthy environments in neighbourhoods with a ‘health deficit’. x

Research and

design

Develop tools and use research by design. x x

Make health-promoting interventions in the physical environment more evidence-based and invest in

mutual learning through multiyear pilots and research programmes.

x x

Finance and

governance

Consider health benefits, not just health risks, when making investment decisions on the built

environment. Involve stakeholders in outcomes and follow-up activities.

x x

Remove obstacles to parties that want to invest in a healthy environment. x

Overcome government fragmentation in the area of health and the environment and work in

interdisciplinary teams.

x x

12PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

It is safe to expect that environmental standards will be tightened in the

future. Discoveries continue to be made about harmful environmental

factors, such as ultrafine particles. Public opinion also seems to be shifting:

there is growing public support for meeting environmental standards, as

illustrated by the lawsuit against the Dutch state regarding air pollution.

Some municipalities are already trying to comply with WHO norms,

which go beyond EU standards. In January 2018, the Health Council of the

Netherlands issued a report on air quality that called for standards even

tougher than the WHO norms. In view of this trend, the Council feels that

the national government should prepare for tighter standards in the near

future. One way would be to consider the challenges posed by a scenario

where WHO air quality norms are adopted.

The Council feels that, if local circumstances dictate, tougher local

standards could be imposed, again, after due consideration of all relevant

factors. The Environment and Planning Act and its associated orders

in council introduce options for setting local environmental norms that

go beyond national standards. This can be helpful when urgent local

environmental problems are affecting a large population. Recommendation

4 will discuss how potential drawbacks of stricter environmental standards

(e.g. creating development lockdowns) can be prevented.

Box 2: Legal environmental standards and guidelines recommended by

health experts

Environmental quality guidelines recommended by health professionals

(Dutch: gezondheidskundige advieswaarden) are exposure levels where

no harmful health effects can be expected (Gezondheidsraad, 2016).

These are set with a single goal in mind: human health. Environmental

standards in Dutch law are different. They are adopted after considering

multiple factors such as economic aspects, technical feasibility

and health impacts. The environmental standards set by law in the

Netherlands are therefore not identical to those levels recommended by

health professionals. Damage to health can still occur under the legal

standards.

Recommendation 2: Focus more on promoting health in environmental

and planning policy and look further than environmental measures to

achieve this.

The promotion of health in the broad sense of the word should be

elaborated further in environmental and planning policy in order to bring

the quality of the environment up to a level that enables and encourages

healthy choices. At least three major routes are available: exercise,

relaxation and social engagement. Translated into urban design, this means

providing infrastructure that stimulates exercise (non-motorised transport,

sports and games), public space that facilitates relaxation and social

contact (squares, neighbourhood configuration, but also greenways to the

13PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

countryside) and a built environment that enables healthy behaviour. This

is summarised in Table 2. Various domestic and international examples

show how this can be done.

The Council feels that a multi-level approach is unavoidable for promoting

health through environmental and planning policy that spans from the

micro level (e.g. a healthy school environment) to the neighbourhood

and citywide level. Different challenges manifest themselves at different

levels and require different solutions. Which environmental intervention is

ultimately chosen strongly depends on the local setting and the needs of

residents and other users.

A health-conscious urban environment enables and facilitates healthy

choices. Without behavioural change, interventions in the physical

environment do not automatically produce health benefits – ‘you can lead

a horse to water, but you can’t make it drink’. Simply constructing bicycle

paths does not mean more cycling, for example. It is therefore essential to

apply knowledge about human behaviour when designing interventions in

the built environment (Rli, 2014).

Table 2: Promoting health through environmental factors

Infrastructure Non-motorised transport infrastructure: promoting

exercise by building networks of footpaths, bicycle

routes, parks and ‘green ribbons’, bicycle storage

facilities, etc.

Public space Exercise, relaxation and social contact by providing

attractive and diverse places. Green spaces in, around

and at an acceptable distance from the city. Public

gathering spaces, a wide range of amenities, variation

between built and non-built space, restful places (quiet)

and water features, greenways to and from green spaces

outside the city.

Buildings

and their

environs

Not just protecting, but also promoting health in

buildings and their environs. Examples include directing

movement through buildings, alternating between busy

and tranquil spaces and providing surrounding green

space to help improve health.

14PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

Recommendation 3: Seek, from a health perspective, synergies with major

transition challenges such as sustainable urban development, mobility,

climate change adaptation and the energy transition.

It is imperative that major transition challenges for the physical

environment are rethought from a health point of view. Decisions taken

with respect to these challenges can have far-reaching implications for

health. There are threats, but also opportunities, especially for urban

development and densification, sustainable transport, climate change

adaptation and the energy transition (see also Rli, 2016). The Council

recommends looking for synergies between challenges. How can health

benefits be gained through environmental policy and how can better health

contribute towards the transitions in the physical environment? Decisions

on these transitions can affect health and vice versa.

The sustainable urban development challenge concerns where homes

should be built to meet future demand: mainly brownfield or also

greenfield development? Many municipalities are seriously considering

densification (see also Vereniging Deltametropool, 2017). Attractive public

space designed with health in mind can help residents make healthy

choices. Cities bisected by main roads have fewer options due to the

environmental constraints on housing development near these roads.

This is where the challenge of sustainable urban development meets that

of infrastructure and health. The national government needs to be aware

of this interdependence: if it opts for development within existing urban

areas in its upcoming National Environment Strategy (NOVI), this will have

ramifications for the development of infrastructure in and around cities.

For example, it may require investments in noise reduction, lower speed

limits, diverting routes for hazardous materials or tunnels. The Council’s

call to rethink the transition challenges from a health point of view is also

important for gaining public support: if no regard is given to a healthy

environment, support for new development in existing urban areas is likely

to evaporate quickly.

The mobility transition is about the shift towards sustainable mobility, such

as public transport, walking, cycling and more sustainable car use. It will

involve some threats to health, but also opportunities. Choices made at the

national level can impact those at a regional or local level. If the national

government raises the speed limit on national motorways, for example,

this will affect the environment around these motorways. Even if the air

quality remains within the legal limits, it will still be worsened by the higher

speed limit. Electric vehicles (delivery vans, buses and private cars), on

the other hand, present an opportunity to improve air quality and, in turn,

generate health benefits.

A third example is the challenge of climate change adaptation. This also

has various links to health. Green urban spaces capture excess rainfall,

while also contributing to human health by reducing the urban heat island

effect and encouraging exercise and social contact (Gezondheidsraad, 2017;

Ministerie van Infrastructuur en Milieu [I&M], 2016).

15PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

The fourth and final example is the energy transition. According to the

government coalition agreement, this includes greening the housing

stock, with insulation as a first step (Tweede Kamer, 2017a). However,

insulation can have both beneficial and detrimental effects on the indoor

environment, and therefore on health. On the one hand, it leads to more

stable temperatures, but on the other hand, it may lead to higher humidity

(in case of insufficient ventilation) and risks of contagion (insufficient

filtering of harmful organisms). Current ventilation norms for insulated

homes offer no guarantee of healthy air quality if the behaviour of residents

is not taken into account: after all, they are the ones who will have to

ventilate their homes and install proper filters. The Council recommends

paying specific attention to health effects when dealing with government

real estate and schools and when negotiating with housing associations

about improving the energy efficiency of the housing stock. Disconnecting

homes from the natural gas network, part of the decarbonisation challenge

in the energy transition, also has linkages to health: less fossil fuel burning

in homes can contribute to a healthy indoor environment.

Recommendation 4: Include ambitions for a healthy built environment in

environment strategies and use the instruments in the Environment and

Planning Act to realise them.

The procedure of drawing up environment strategies can be used to arrive

at shared and widely accepted ambitions for a healthy living and working

environment. The procedure for preparing strategies should include a

broad-based participatory process with parties such as businesses, housing

associations, property developers, insurance companies, grassroots

organisations and of course individuals (see also Inspiratiegids Participatie,

Ministerie van I&M, 2017a; www.platformdgo.nl). The many grassroots

initiatives in the area of health and environmental quality testify to the

engagement of people; their know-how can be put to better use.

The Environment and Planning Act says little about the content of the

environment strategy. The Council feels that public authorities should

be explicit about the necessity and/or desirably of setting high ambitions

for a healthy environment. Without extra efforts to improve health, the

regulations and standards included in the Environment and Planning

Act and the application of environmental principles can only guarantee

minimum levels of health protection. Of course, the decisions made by

authorities will depend on the severity of the problems in their jurisdiction.

If municipalities, provinces or the national government wish to set higher

goals for a healthier environment, they can make different types of

arrangements for attaining these goals in their environment strategies.

Options include clearly defining the concepts ‘health’ and ‘healthy

environment’ in the strategy, seizing opportunities created by synergy

with other activities, working across scales and mapping areas with a

health deficit and drawing up action plans. A target group approach is also

possible, such as providing healthy environments for those with certain

disabilities (e.g. blindness, Alzheimer’s) or the safe and healthy design of

school grounds.

16PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

The Council believes that the National Environment Strategy (NOVI)

currently being drawn up should set specific goals for a healthy

environment. The inception report rightly listed ‘health and safety in

the built and natural environment’ as one of its eleven environmental

challenges (Ministerie van I&M, 2017b). Consideration could be given to

setting up urban living labs in areas facing major health challenges and

where a national interest is at stake. If the national government shows

real ambition on environmental health, this can motivate subnational

authorities to follow suit.

The Council recommends that public authorities make use of the other

instruments in the Environment and Planning Act and associated orders

in council to achieve the ambitions set out in environment strategies.

These include physical environment plans, implementation programmes,

environmental permits, soliciting advice from the community health service

(GGD) under provisions of the Public Health Act (Wet publieke gezondheid)

and formulating bespoke or supplementary environmental standards.

Apply municipal programmes selectively to avoid ‘development lockdowns’

The ‘local environmental standards’ instrument provides subnational

authorities with a means to pursue their ambitions for a healthy

environment. However, tougher local environmental standards can

detrimentally affect urban development in the short term. Tighter

standards only come into effect once planning permission is requested

and affect parties that want to ‘do something’ in a particular area, such

as build a school, home or business. The new standards may block such

initiatives and effectively create a ‘development lockdown’ in the area. The

programmatic approach in the Environment and Planning Act can offer a

way out of this dilemma. Years of experience have been gained with the

National Cooperative Air Quality Programme (NSL). The Environment and

Planning Act translates this approach into a generic instrument available to

all levels of government (Tweede Kamer, 2014), enabling them to comply

with (existing or stricter) environmental standards while still permitting

new developments in a particular area. Environmentally damaging projects

or activities are offset by measures to improve environmental quality so

that the required or desired levels are still reached. This can be an attractive

instrument, especially for those areas where new developments are

envisioned, but which also have an urgent need to improve environmental

quality. Depending on their ambitions, authorities can opt for a local

environmental standard equal to or stricter than the national standard.

Recommendation 5: Prioritise the promotion of healthy environments in

neighbourhoods with a ‘health deficit’.

Investments in the built environment to improve health should be targeted

to those areas where substantial health benefits can be attained, namely,

those with a ‘health deficit’. In the Netherlands, large gaps exist in life

expectancy or healthy remaining years (i.e. according to the narrow

definition of health) between neighbourhoods. The chances of growing

old in good health are much lower in some areas than in others. By far the

most important explanation of health differences between neighbourhoods

is the spatial distribution of people: the poor often have little alternative

17PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

but to live in cheap social housing in neighbourhoods that are unpopular

for physical, environmental and social reasons (PBL, 2016, p. 25).

Neighbourhoods are, in other words, ‘not the causes, but primarily the

manifestation of disadvantage’ (Hamers, 2016, p. 69).

It is not easy to reduce health disparities between neighbourhoods.

Not all of these differences can be solved with investments in the

physical environment anyway; they also demand socioeconomic policy.

Nevertheless, residents can still benefit from health-promoting measures

in the built environment. For example, easily accessible pavements

(enhancing walkability) make it easier to go outside and interact with

others. The local setting and needs of residents should be the starting

point, something that was put into practice by the project Kijk! Een

gezone wijk (Look! A healthy neighbourhood) in Amsterdam’s Slotermeer

neighbourhood (Den Broeder, 2017). In this project, residents used an app

to score their neighbourhood in terms of health, highlighting the good and

bad places and features, which produced an overview of their priorities.

In this case, friendliness and good contact between neighbours were

considered just as important for health as green spaces or sports facilities

(Hogeschool van Amsterdam, 2016).

3.2 Recommendations for knowledge creation and research by design

Recommendation 6: Develop tools and use research by design.

Develop tools to visualise the health situation in a systematic way

New tools are needed to support municipal policy on environmental health

that can visualise current health levels, carry out stress tests or generate

a health map. Standardisation of data and categories is essential for

comparing outcomes and benchmarking. For instance, what data should be

included on a city’s health map and what should be included in the legend?

The legend created in the design studios carried out in preparation of this

advisory report includes human health scores, environmental risks (e.g. air

pollution), healthcare and sports facilities and green spaces (e.g. parks).

Other data are also conceivable.

Regardless of the form the tools ultimately take, the underlying objective

is always the same. They must show the current health situation in the

city at a glance and allow for comparisons within and between cities.

Disappointing scores on the benchmark, stress test or map can spark

debates in the local media, stimulate individuals and businesses to become

more involved and increase the efforts made by public authorities. To

encourage this, the Council suggests that the national government initiate

a few pilot projects. One example would be to create a health map for a

number of cities. Another would be to develop an environmental health

stress test, analogous to the climate change stress test, which could depict

vulnerable areas in various scenarios. It would be helpful if all existing

18PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

health data were accessible from a single location. A suitable place for

a ‘health data portal’ would be within the digital system supporting the

Environment and Planning Act.4

4 Information portals supply data that can be used for spatial planning processes.

Use research by design techniques

The Council advises using urban design workshops to help translate

health ambitions into interventions in the physical environment. These

workshops serve multiple ends: they provide settings to draw up health-

improving interventions while also providing settings where parties from

different disciplinary backgrounds, such as health and the environment,

learn to speak each other’s language. The Council has already practised

using this method: it set up workshops led by urban design agencies in

which local authority planners and urban designers, health professionals

and knowledge managers worked together on ways to develop healthy

cities. In the process, the participants encountered some new challenges.

For example, health professionals work primarily with hard quantitative

data while urban designers work with more visual material (see also RIVM,

2015). How can an urban designer translate healthcare data into spatial

imagery? Other parties can also be invited to attend the workshops, such

as property developers, residents, social workers and politicians. This

may ultimately produce attractive images of the city that can inspire the

participants to step up their efforts to create a healthy built environment.

Recommendation 7: Make health-promoting interventions in the physical

environment more evidence-based and invest in mutual learning through

multiyear pilot projects and research programmes.

Invest in creating knowledge about promoting health in the built

environment

Seizing opportunities to achieve health benefits through environmental and

planning policy depends on having a well-organised body of knowledge,

particularly information about how environmental factors can promote

health in the broadest sense (i.e. social wellbeing and control over one’s

life, in addition to physical health). After all, a large and longstanding body

of knowledge already exists about harmful environmental factors. The

acquisition of knowledge should be much more systematic by performing

baseline measurements before conducting experiments and then taking

follow-up measurements, and by studying cost-effectiveness and the

influence of local factors. Multiyear programmes are needed to study the

long-term effects of interventions. Furthermore, one must remain vigilant

about new health risks that can emerge from environmental trends, such as

climate change.

Invest in mutual learning through multiyear pilot projects and research

programmes

Sharing knowledge is a precondition for disseminating and applying best

practices, a practice also known as upscaling. It is therefore important that

cities share their experiences about promoting a healthy environment – not

just within or between public authorities, but also with businesses and civil

19PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

society. This is already happening in an ad hoc manner. During the various

meetings and discussions held in the preparation of this advisory report,

a frequent comment was that ‘it seems like everybody is busy reinventing

the wheel’. Building on the PBL’s evaluation of the Dutch city deals (Hamers

et al., 2017a, 2017b), the Council feels that the national government could

be more proactive in bringing together the best practices of the pilot

projects to stimulate mutual learning and knowledge-sharing. Various

pilot projects should be continued, such as those carried out under the

Urban Agenda (city deals) and Smart and Healthy City (living labs, pilot

cities) programmes. In so doing, attention should be paid to the systematic

sharing of lessons within a larger network. In addition, this should be

accompanied by a multiyear research programme that systematically

monitors the effects of interventions in the built environment as well as the

intervention mechanisms. Finally, the right conditions need to be created

(e.g. with respect to resources, participants and process architecture) to

allow the results of pilot projects to be taken up into regular policy upon

completion.

3.3 Recommendations on strengthening the financial base and

improving governance for a healthy environment

Recommendation 8: Consider health benefits, not just health risks, when

making decisions about investments on the built environment. Involve

stakeholders in outcomes and follow-up activities.

Investments in the built environment should not only take the costs of poor

health into account, but also the benefits of good health. This will make it

easier to make a case for investing in environmental quality. Cost-benefit

analyses should therefore incorporate health benefits more often than they

do now, for example, by making these explicit and assigning a monetary

value to the effects of environmental interventions on health (PBL, 2012).

One example is the report Bruto Utrechts Fietsproduct (Decisio, 2017a),

which examined the various benefits of increased cycling, including health.

Another example is the WHO’s Health Economic Assessment Tool (HEAT),

which ascribes economic values to the impacts of walking and cycling

on health (WHO, 2017). A report published in 2017 lists the valuations

assigned to cycling in various cost-benefit analyses, including one on

health impacts (Decisio, 2017b).

It is vital to involve stakeholders in the outcomes and follow-up activities

of health impact studies. Parties such as residents, businesses, grassroots

initiatives and civil society organisations all have an interest in, or

experience the effects of, a healthy built environment. Understanding the

20PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

benefits a healthy environment brings will enhance support for ‘healthy

alternatives’ and provide an incentive to co-invest.

Recommendation 9: Remove obstacles to parties that want to invest in a

healthy environment.

Not only public authorities, but also businesses, property developers,

pension funds, housing associations and insurance companies should

be allowed to invest in health-promoting interventions in the built

environment. Anyone wishing to participate in this manner should be able

to do so. As we shall see, legal requirements or split incentives can act as

barriers. The Council feels that the national government has a responsibility

to remove these obstacles. This is evident in the following two examples.

The first case regards the legal framework governing housing associations.

The 2015 Housing Act grants housing associations little room to invest in

neighbourhood liveability or property such as community or youth centres.

From an environmental health perspective, this is a step backwards.

Public facilities perform important functions as meeting places, which is

conducive to health. This point should be explored further in the evaluation

of the Housing Act in 2018, and the national government should ensure it is

included in the research remit.

The second case concerns the split-incentive problem. This refers to a

situation in which an investment’s benefits are not enjoyed by the investor

(usually the municipality in this case), but by a third party (usually an

insurance company, due to lower healthcare costs). This undermines the

willingness to invest, and makes it harder to get improvement plans off the

ground. Although it is legally possible for insurance companies to co-invest

in the physical environment, they are – with some exceptions – hesitant

to do so. Much depends on the discretionary behaviour of insurance

companies, and whether they feel this gives them an opportunity to

establish a distinctive profile in health prevention. The national government

should stimulate insurance companies to invest in a healthier environment,

by for example, creating ‘prevention coalitions’ (e.g. for areas with a health

deficit) similar to those being set up at the local level for at-risk groups

(Tweede Kamer, 2016). These coalitions would be between a municipality

and one or more insurance companies, with co-funding from the national

government.

Recommendation 10: Overcome government fragmentation in the area of

health and the environment and work in interdisciplinary teams.

If public authorities wish to include health in their environmental and

planning policies, they will need to overcome the fragmentation and

silo-thinking of government bureaucracy. This currently poses many

problems for officials in their day-to-day routines. Within the national

government, responsibility for environment and health is spread across

many government departments: Interior and Kingdom Relations (BZK),

Infrastructure and Water Management (I&W), Health, Welfare and Sport

(VWS) and Economic Affairs and Climate Policy (EZK). Fragmentation

is also endemic within provincial and municipal authorities (e.g. across

21PRINTTHE HEALTHY CITY | PART 1: ADVICE | CHAPTER 3

departments such as urban development, mobility, health, nature,

employment, etc.). This has created perennial discussions about powers

and responsibilities between and within tiers of government (i.e. who

should deal with this?). Worse, there is often no common language. Finally,

since environmental health is usually a secondary responsibility, there is a

risk of it falling by the wayside when more urgent matters arise. In order to

prevent this from happening, the Council argues for organisational reform:

officials should work together more in interdisciplinary teams (e.g. with

staff from public health, spatial planning and sports). This will help officials

to learn each other’s language and way of thinking.

A holistic perspective is also necessary among politicians, both between

and within tiers of government, and public authorities depend on each

other’s cooperation for this. There are many interactions between the social

and physical health domains (e.g. issues like health disparities, obesity,

ageing, cycling, water, energy and the design of the built and natural

environment). In its ambition to become a ‘healthy city’, the municipality of

Utrecht now only adopts policies once the executive councillors for urban

development and health have both given their approval. The Council urges

all government authorities to follow Utrecht’s example.

Figure 2: Fragmentation of environmental health policy across ministries

BZKEnvironment and Planning Act

National Environment Strategy (NOVI)

Urban Agenda - City Deals

EZKEnergyClimate Change

IenWEnvironment - Smart and Healthy City

WaterTransport

VWSPublic health- National

prevention programme

- Health in…

Healthy environment

22PRINT

REFERENCES BETA office (2016). Beweeglogica in gebouwen. Amsterdam: BETA office for

architecture and the city.

Broeder, J. M. den (2017). Citizen Science for Health in All Policies: Engaging

communities in knowledge development. Amsterdam: Vrije Universiteit.

Decisio (2017a). Bruto Utrechts Fietsproduct: Wat levert een toename van

fietsgebruik de stad op? Amsterdam.

Decisio (2017b). Waarderingskengetallen MKBA Fiets: state-of-the-art.

Den Haag: Ministerie van Infrastructuur en Waterstaat.

Gemeente Venlo (2017). Stadskantoor Venlo: meer dan alleen duurzaam.

Geraadpleegd op 12 oktober 2017 via http://stadskantoorvenlo.nl/

Gezondheidsraad (2013). Een gezond binnenmilieu in de toekomst.

Den Haag.

Gezondheidsraad (2016). Meewegen van gezondheid in omgevingsbeleid:

evenwichtig en rechtvaardig omgaan met risico’s en kansen. Den Haag.

Gezondheidsraad (2017). Gezond groen in en om de stad. Den Haag.

Gezondheidsraad (2018). Gezondheidswinst door schonere lucht. Den Haag.

Hamers, D. (2016). De innovatieve stad: hoe steden met slagkracht, maat-

werk en leervermogen kunnen bijdragen aan economische, groene en

sociale innovaties. Achtergrondstudie. Den Haag: PBL.

Hamers, D., Dignum, M. & Evers, D. (2017a). Evaluatie City Deals. Den Haag:

PBL.

Hamers, D., Dignum, M. & Evers, D. (2017b). Evaluatie City Deals – vervolg.

Den Haag: PBL.

Hogeschool van Amsterdam (2016). Kijk! Een gezonde wijk. Geraadpleegd

op 12 oktober 2017 via http://www.hva.nl/urban-management/gedeelde-

content/projecten/projecten-algemeen/kijk-een-gezonde-wijk.html

23PRINTTHE HEALTHY CITY | REFERENCES

International WELL Building Institute (2014). The WELL Building Standard.

Geraadpleegd op 21 november 2017 via https://www.wellcertified.com/

en/explore-standard

Jaar van de Ruimte (2015). Manifest2040: wij maken Nederland samen.

Den Haag.

Ministerie van Infrastructuur en Milieu (2016). Nationale klimaatadaptatie-

strategie 2016 (NAS): aanpassen met ambitie. Den Haag.

Ministerie van Infrastructuur en Milieu (2017a). Aan de slag met de

Omgevingswet: inspiratiegids participatie Omgevingswet. Geraadpleegd

op 24 juli 2017 via https://aandeslagmetdeomgevingswet.nl/aandeslag/

thema/participatie/inspiratiegids/

Ministerie van Infrastructuur en Milieu (2017b). De opgaven voor de

Nationale Omgevingsvisie: startnota. Den Haag.

Omgevingswet (2016). Wet van 23 maart 2016, houdende regels over het

beschermen en benutten van de fysieke leefomgeving (Omgevingswet).

Staatsblad, 2016 (156). Geraadpleegd via https://zoek.officielebekend-

makingen.nl/stb-2016-156.html

Planbureau voor de Leefomgeving (2012). Gezondheid in maatschappelijke

kosten-batenanalyses van omgevingsbeleid. Den Haag.

Planbureau voor de Leefomgeving (2016). Balans van de Leefomgeving

2016: richting geven, ruimte maken. Den Haag.

Raad voor de leefomgeving en infrastructuur (2014). Doen en laten:

effectiever milieubeleid door mensenkennis. Den Haag.

Raad voor de leefomgeving en infrastructuur (2016). Opgaven voor

duurzame ontwikkeling: hoofdlijnen uit vier jaar advisering door de Raad

voor de leefomgeving en infrastructuur. Den Haag.

Rijksinstituut voor Volksgezondheid en Milieu (2014). VTV 2014:

Volksgezondheid Toekomst Verkenning. Deelrapporten: determinanten.

Geraadpleegd op 13 oktober 2017 via http://eengezondernederland.nl/

Een_gezonder_Nederland

Rijksinstituut voor Volksgezondheid en Milieu (2015). Ruimte en gezond-

heid: een vanzelfsprekende combinatie? Bilthoven.

Rijksinstituut voor Volksgezondheid en Milieu (2017). Themaverkenning

Bredere determinanten van gezondheid. Volksgezondheid Toekomst

Verkenning 2018. Bilthoven.

Tweede Kamer (2014). Memorie van Toelichting: regels over het

beschermen en benutten van de fysieke leefomgeving (Omgevingswet).

Vergaderjaar 2013-2014, 33 962, nr. 3.

Tweede Kamer (2016). Preventief gezondheidsbeleid, brief van de minister

en staatssecretaris van volksgezondheid, welzijn en sport aan de voor-

zitter van de Tweede Kamer, 25 maart 2016. Vergaderjaar 2015–2016, 32

793, nr. 213.

Tweede Kamer (2017a). Vertrouwen in de toekomst. Regeerakkoord 2017 –

2021 VVD, CDA, D66 en ChristenUnie. Vergaderjaar 2017-2018, Bijlage bij

Kamerstuk 34 700, nr. 34.

Tweede Kamer (2017b). Monitoringsrapportage NSL 2017, brief van de

staatssecretaris van Infrastructuur en Waterstaat aan de voorzitter van de

Tweede Kamer. Vergaderjaar 2017-2018, 30 175, nr. J.

24PRINTTHE HEALTHY CITY | REFERENCES

Vereniging Deltametropool (2017). Verstedelijkingsopgave van Nederland.

In opdracht van IPO, G4 en G32. Geraadpleegd op 12 oktober 2017,

via https://www.dropbox.com/s/mwmc9rw5m6r4u9p/20170901_

VERSTEDELIJKINGSOPGAVE_VAN_NEDERLAND_IPO_G4_G32_WEB.

pdf?dl=0

Wet publieke gezondheid (2008). Geraadpleegd op 24 oktober 2017 via

http://wetten.overheid.nl/BWBR0024705/2016-08-01

WBGU (2016). Humanity on the move: unlocking the transformative power

of cities. Summary. Berlin: German Advisory Council on Global Change

WBGU.

World Health Organization (2017). Health economic assessment tool (HEAT)

for walking and for cycling: Methods and user guide on physical activity,

air pollution, injuries and carbon impact assessments. Geraadpleegd op

14 december 2017, via http://www.euro.who.int/en/health-topics/envi-

ronment-and-health/Transport-and-health/activities/guidance-and-tools/

health-economic-assessment-tool-heat-for-cycling-and-walking

25PRINT

APPENDICES RESPONSIBILITY AND ACKNOWLEDGEMENTS

Advisory committee

W.E.M (Ellen) Peper, Council member and committee chair

S.P. (Sybren) Bosch MSc, junior-Council member

L. (Leendert) van Bree PhD, external committee member

(Business Development/Urban futures and health)

Prof. P. (Pieter) Hooimeijer PhD, Council member

Project team

L.B.J. (Lianne) van Duinen PhD, team leader

D. (Dominique) Blom

M.L. (Mirjam) van Gameren, assistant

M.R.P. (Michiel) Ooms

Consultees

Annelies Acda, Pharos

Frans Baar, Leerhuizen palliatieve zorg

Rianne van den Berg, GGD IJsselland

Josine van den Bogaard, GGD Rotterdam-Rijnmond

Inge van den Broek, GGD Brabant-Zuidoost

Patries van den Broek, Gemeente Zwolle

26PRINTTHE HEALTHY CITY | RESPONSIBILITY AND ACKNOWLEDGEMENTS

Joop ten Dam, Windesheim Hogeschool

Gabor Everraert, Gemeente Rotterdam

Mathijs Dielissen, Gemeente Eindhoven

Albertine Van Diepen, Raad voor Volksgezondheid en Samenleving

Mariëlle Dijkers, Rijksvastgoedbedrijf

Frans Dijstelbloem, Gemeente Eindhoven

Sies Dogger, Gezondheidsraad

Marjon Drijver, Gezondheidsraad

Annette Duivenvoorden, Platform31

Saskia Engbers, Gemeente Zwolle

Francesco Franchimon, Blue Building Institute

Paul Geurts, Gemeente Nijmegen

Ronald van der Graaf, Rijksinstituut voor Volksgezondheid en Milieu

Janneke Greveling, Gemeente Zwolle

Marije van Hal, GGD IJsselland

David Hamers, Planbureau voor de Leefomgeving

Frank den Hertog, Rijksinstituut voor Volksgezondheid en Milieu

Guus de Hollander, Planbureau voor de Leefomgeving

Liesbeth van Holten, Provincie Utrecht

Maarten Hoorn, Platform31

Henk Hilderink, Rijksinstituut voor Volksgezondheid en Milieu

Marjolijn Keverling, Gemeente Rotterdam

Edwin Koster, Gemeente Utrecht

Lisanne Kusters, Rijkswaterstaat Zuid-Nederland

Pim Lamers, GGD Brabant Zuidoost

Frederik Leenders, Gemeente Utrecht

Stijnie Lohof, Gemeente Rotterdam

Hetty Linden, Gemeente Utrecht

Lara Muller, Blue Building Institute

Roel Nijsten, Rijkswaterstaat

Frank Pierik, TNO

Nanda Piersma, Hogeschool van Amsterdam

Nico Pieterse, Planbureau voor de Leefomgeving

Aldien Poll, Pharos

Hetty van Rhijn, Gemeente Rotterdam

Henk Snel, Gemeente Zwolle

Birgit Staatsen, Rijksinstituut voor Volksgezondheid en Milieu

Sjouke van der Vlugt, Gemeente Groningen

Mariëtte van der Voet, Nederlandse Sportraad

Bert Vos, Gemeente Schiedam

René Vrugt, Rijkswaterstaat

Monica van Wingerden, Nederlandse Sportraad

Jaap de Wolf, GGD Twente/IJsselland

Fred Woudenberg, GGD Amsterdam

Dries Zimmermann, Gemeente Rotterdam

Departmental consultees

Gert-Jan Buitendijk, Ministerie van BZK

Natalie Burgers, Ministerie van BZK

Saniye Çelik, Ministerie van BZK

Maurice Cramers, Ministerie van BZK

Bert van Delden, Ministerie van BZK

27PRINTTHE HEALTHY CITY | RESPONSIBILITY AND ACKNOWLEDGEMENTS

Rianne Dobbelsteen, Ministerie van IenM

Arjan van Drielen, Ministerie van VWS

Marjolein van Gelder, Ministerie van BZK

Vincent van der Gun, Ministerie van IenM

Peter Heij, Ministerie van IenM

Evelyn Hijink, Ministerie van IenM

Eline van der Hoek, Ministerie van IenM

Willemieke Hornis, Ministerie van IenM

Mirelle Kolnaar, Ministerie van IenM

Rene Korenromp, Ministerie van IenM

Chris Kuijpers, Ministerie BZK/IenM

Floor Langendijk, Ministerie van BZK

Roald Lapperre, Ministerie van IenW

Ferdi Licher, Ministerie van BZK

Patricia Palmen, Ministerie van IenM

Edwin Scherbeijn, Ministerie van BZK

Henk Soorsma, Ministerie van VWS

Brenda Vervoorn, Ministerie van IenM

Aldert de Vries Ministerie van BZK

Anja Zantinge, Ministerie van VWS

Design offices

Marco Broekman, marco.broekman urbanism research architecture

Joske Bruijns, marco.broekman urbanism research architecture

Floris van der Zee, marco.broekman urbanism research architecture

Maureen Kogelman, Buro MA.AN

Sven van Oosten, Buro MA.AN

Herman Reezigt, Buro MA.AN

Han Dijk, Bureau Posad

Karlijn Kokhuis, Bureau Posad

Reviewers

Hans Leeflang, voormalig IenM projectdirecteur ‘Jaar van de Ruimte’

Joost Schrijnen, Spatial management consultant

Fleur Spijker, gemeenteraadslid Leiden, TK advocaten

Eef Spronck, TwentyOne

28PRINTTHE HEALTHY CITY | OVERVIEW OF PUBLICATIONS

OVERVIEW OF PUBLICATIONS

2018

Healthy and Sustainable: Working together towards a sustainable

food system [‘Duurzaam en gezond: Samen naar een houdbaar

voedselsysteem’]. March 2018 (Rli 2018/02).

Electricity Provision in the Face of Ongoing Digitalisation

[‘Stroomvoorziening onder digitale spanning’]. February 2018 (Rli 2018/01).

2017

A Broad View of Heritage: The Interactions between Heritage and

Transitions in the Physical Environment [‘Brede blik op erfgoed: over de

wisselwerking tussen erfgoed en transities in de leefomgeving’]. December

2017 (Rli 2017/03).

Energietransitie en Leefomgeving: kennisnotitie. December 2017.

[only available in Dutch].

Land for Development: Land Policy Instruments for an Enterprising Society

[‘Grond voor Gebiedsontwikkeling: Instrumenten voor grondbeleid in een

energieke samenleving’]. June 2017 (Rli 2017/02).

Assessing the Value of Technology: Guidance Document [‘Technologie op

waarde schatten: Een handreiking’]. January 2017 (Rli 2017/01).

2016

Faster and Closer: Opportunities for Improving Accessibility in Urban

Regions [‘Dichterbij en sneller: kansen voor betere bereikbaarheid in

stedelijke regio’s’]. December 2016 (Rli 2016/05).

International Scan 2016: Emerging Issues in an International Context.

November 2016 (Rli/EEAC).

The Connecting Landscape [‘Verbindend landschap’]. November 2016

(Rli 2016/04).

Challenges for Sustainable Development: Main Focus Areas Identified in

Advisory Reports Published in the Past Four Years by the Council for the

Environment and Infrastructure [‘Opgaven voor duurzame ontwikkeling:

hoofdlijnen uit vier jaar advisering door de Raad voor de leefomgeving en

infrastructuur’]. July 2016 (Rli 2016/03).

Beyond Mainports [‘Mainports voorbij’]. July 2016 (Rli 2016/02).

29PRINTTHE HEALTHY CITY | OVERVIEW OF PUBLICATIONS

System Responsibility in the Physical Living Environment. [‘Notitie

Systeemverantwoordelijkheid in de fysieke Leefomgeving’ – only available

in Dutch]. May 2016 (Rli 2016/01).

2015

Reform of Environmental Law: Realise your Ambitions [‘Vernieuwing

omgevingsrecht: maak de ambities waar’]. December 2015 (Rli 2015/07).

A Prosperous Nation Without CO2: Towards a Sustainable Energy Supply

by 2050 [‘Rijk zonder CO2: naar een duurzame energievoorziening in 2050’].

September 2015 (Rli 2015/06).

Room for the Regions in European Policy [‘Ruimte voor de regio in

Europees beleid’]. September 2015 (Rli 2015/05).

Changing Trends in Housing: Flexibility and Regionalisation Within Housing

Policy [‘Wonen in verandering: over flexibilisering en regionalisering in het

woonbeleid’]. June 2015 (Rli 2015/04).

Stelselherziening omgevingsrecht. May 2015 (Rli 2015/03).

Circular Economy: From Wish to Practice [‘Circulaire economie: van wens

naar uitvoering’]. June 2015 (Rli 2015/02).

Survey of Technological Innovations in the Living Environment

[‘Verkenning technologische innovaties in de leefomgeving’]. January 2015

(Rli 2015/01).

2014

Managing Surplus Government Real Estate: Balancing Public Interest and

Financial Gain [‘Vrijkomend rijksvastgoed: over maatschappelijke doelen en

geld’]. December 2014 (Rli 2014/07).

Risks Assessed: Towards a Transparent and Adaptive Risk Policy [‘Risico’s

gewaardeerd: naar een transparant en adaptief risicobeleid’]. June 2014

(Rli 2014/06).

Recovering the Costs of Environmental Damage: Advisory Letter on

Financial Indemnity to be Provided by High-Risk Companies [‘Milieuschade

verhalen: advies financiële zekerheidstelling milieuschade Brzo- en IPPC4-

bedrijven’]. June 2014 (Rli 2014/05).

International Scan 2014: Signals: Emerging Issues in an International

Context [‘Internationale verkenning 2014. Signalen: de opkomende

vraagstukken uit het internationale veld’]. May 2014 (Rli 2014).

The Future of the City: The Power of New Connections [‘De toekomst van

de stad: de kracht van nieuwe verbindingen’]. April 2014 (Rli 2014/04).

30PRINTTHE HEALTHY CITY | OVERVIEW OF PUBLICATIONS

Quality Without Growth: On the Future of the Built Environment [‘Kwaliteit

zonder groei: over de toekomst van de leefomgeving’]. April 2014 (Rli

2014/03).

Influencing Behaviour: More Effective Environmental Policy through Insight

into Human Behaviour [‘Doen en laten: effectiever milieubeleid door

mensenkennis’]. March 2014 (Rli 2014/02).

Living Independently for Longer: A Shared Responsibility of the Housing,

Health and Welfare Policy Domains [‘Langer zelfstandig: een gedeelde

opgave van wonen, zorg en welzijn’]. January 2014 (Rli 2014/01).

2013

Sustainable Choices in the Implementation of the Common Agricultural

Policy in the Netherlands [‘Duurzame keuzes bij de toepassing van het

Europese landbouwbeleid in Nederland’]. October 2013 (Rli 2013/06).

Pulling Together: Governance in the Schiphol/Amsterdam Metropolitan

Region [‘Sturen op samenhang: governance in de metropolitane regio

Schiphol/Amsterdam’]. September 2013 (Rli 2013/05).

Safety at Companies Subject to the Major Accidents Risks Decree:

Responsibility and Effective Action [‘Veiligheid bij Brzo-bedrijven:

verantwoordelijkheid en daadkracht’], June 2013 (Rli 2013/04).

Dutch Logistics 2040: Designed to Last [‘Nederlandse logistiek 2040:

designed to last’]. June 2013 (Rli 2013/03).

Nature’s Imperative: Towards a Robust Nature Policy [‘Onbeperkt houdbaar:

naar een robuust natuurbeleid’]. May 2013 (Rli 2013/02).

Room for Sustainable Agriculture [‘Ruimte voor duurzame landbouw’].

March 2013 (Rli 2013/01).

2012

Keep Moving, Towards Sustainable Mobility. Edited by Bert van Wee.

October 2012 (Rli/EEAC).

31PRINTTHE HEALTHY CITY

Original title

De stad als gezonde habitat: gezondheidswinst door omgevingsbeleid

Text Editing

Jeanine Mies, MIES/tekst en training

Photo Credits

Cover: Thomas Toledo/Nationale Beeldbank

Infographic

Slimme Financiering, page 5

Graphic Design

Jenneke Drupsteen Grafische vormgeving

Publication Rli 2018/03

April 2018

Translation

Onderosa Language Matters

ISBN 978-90-77166-67-3

NUR 740